Clinical practice guideline. Diagnosis and prevention of colorectal cancer. 2018 Update

Cubiella, Joaquín; Marzo-Castillejo, Mercè; Mascort-Roca, Juan José; Amador-Romero, Francisco Javier; Bellas-Beceiro, Begoña; Clofent-Vilaplana, Joan; Carballal, Sabela; Ferrándiz-Santos, Juan; Gimeno–García, Antonio Z.; Jover, Rodrigo; Mangas-Sanjuán, Carolina; Moreira, Letícia; Pellisé, María; Quintero, Enrique; Rodríguez-Camacho, Elena; Vega-Villaamil, Pablo

doi:10.1016/j.gastre.2018.07.008

Cited by 41 publications

(52 citation statements)

References 3 publications

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“…Colorectal cancer (CRC) diagnosis in symptomatic patients attended in primary healthcare is like looking for a needle in a haystack: symptoms are extremely frequent but CRC is rare [1]. The diagnosis of CRC is based on colonoscopy, an invasive technique with limited availability and associated with severe complications in 1/ 1000 patients [2]. The delay in the diagnosis may worsen prognosis [3] or, at least, produce anxiety.…”

mentioning

confidence: 99%

Not so FAST. Commentary on the article “Appraisal of the faecal haemoglobin, age and sex test (FAST) score in assessment of patients with lower bowel symptoms: an observational study”

Cubiella

2020

BMC Gastroenterol

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A recent study by Digby et al. in BMC Gastroenterology evaluated the faecal haemoglobin, age and sex test (FAST) score in the assessment of patients with lower bowel symptoms attended in primary healthcare. This article is a valuable source of information but the conclusions must be carefully assessed. Authors evaluated the FAST score threshold with a 99% sensitivity (≥ 2.12) for colorectal cancer (CRC). Although the number of patients meeting this criteria is high, 53.5% of the patients not referred initially to secondary healthcare, the results on the patients referred to colonoscopy validate the prediction model. The sensitivity and the specificity for CRC detection were 99.0 and 23.2% with a positive and negative predictive value of 8.0 and 99.7%. Additionally, the sensitivity and the specificity for significant bowel disease were 96.1 and 26.2% with a positive and negative predictive value of 24.3 and 96.1%, consistent with our initial results. To conclude, although we need the information regarding the risk of CRC in those patients not referred to colonoscopy, a FAST Score < 2.12 allows to determine a group of patients with a low risk of CRC detection that requires no further evaluation.

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confidence: 99%

Not so FAST. Commentary on the article “Appraisal of the faecal haemoglobin, age and sex test (FAST) score in assessment of patients with lower bowel symptoms: an observational study”

Cubiella

2020

BMC Gastroenterol

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“…There is already evidence that FIT is a useful tool for the diagnosis of CRC that helps to identify symptomatic patients requiring early colonoscopy [4][5][6][7]17]. In fact, the diagnostic guidance (DG30) of the National Institute for Health and Care Excellence (NICE) and other clinical practice guidelines recommend its use for the assessment of patients with lower gastrointestinal symptoms [2,15]. Despite this, according to our results, the FIT had been used as a diagnostic tool by general practitioners only in 20.7% (n = 317) of all the cases of CRC diagnosed in symptomatic patients, and only 18.3% (n = 279) of cases of CRC were diagnosed after a positive FIT.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, it has been shown that the FIT is a test that identifies, among symptomatic patients, those with the highest risk of having CRC [12,13] and that faecal haemoglobin is the most important factor to be considered when deciding which patients presenting in primary care with lower bowel symptoms would benefit most from referral for colonoscopy [14]. Therefore, its use has been recommended for the assessment of patients with low gastrointestinal symptoms [2,15].…”

Section: Introductionmentioning

confidence: 99%

Impact of the faecal immunochemical test on colorectal cancer survival

et al. 2020

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Background: There is already evidence that the faecal immunochemical test (FIT) is a useful tool for the diagnosis of colorectal cancer (CRC) that helps to identify symptomatic patients requiring early colonoscopy. Although the recommendation to use FIT is widely accepted, there are no data concerning whether this strategy improves patient survival.The objective was to assess whether the survival is higher if CRC patients have been first diagnosed by FIT (as compared with the rest of patients with CRC). Methods: We identified all cases of CRC diagnosed between 2009 and 2016 in Donostialdea (Spain), excluding all the CRC detected in population screening. We focused on symptomatic patients. One thousand five hundred twenty-seven cases of CRC were divided into two groups based on the route to diagnosis: group 1: individuals who tested positive in a FIT during the year before diagnosis, and group 2: others.Survival was assessed by Kaplan-Meier estimation, and with the log-rank test. A Cox regression model was used to adjust for differences between groups due to other variables associated with survival. Results: One thousand nine hundred sixty-seven cases of invasive CRC were identified, of which 22.4% were detected in population screening. Of the 1527 cases diagnosed in symptomatic patients, 317 patients had undergone a FIT in the year before the diagnosis of CRC. In 279 cases(18.3%), the result had been positive and this was the first step towards their CRC diagnosis (group 1). Group 2 was composed of the 1248 cases of CRC (81.7%). Considering these cases, 1210 patients with CRC did not undergo any FIT while 38 patients presented a negative result in the year before the diagnosis. The rate of early-stage disease (stage I or II) was higher in group 1 (51.3% vs 45.5% in group 2) (p = 0.04). Furthermore, the 3-year survival was longer in group 1 (72% vs 59% in group 2) (HR 1.50; 95% CI 1.22-1.84).The variables independently associated with worse survival were: group 2, age > 70 years and stage at the moment of diagnosis. Conclusions: The use of FIT as a diagnostic strategy in symptomatic patients may improve survival in CRC. Nonetheless,FIT is still not widely used in our region.

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“…El cáncer colorrectal (CCR) es una de las neoplasias más frecuentes en los países occidentales. En Argentina es el segundo de mayor mortalidad en ambos sexos con más de 7.000 fallecimientos anuales 1,2,23 . Es una enfermedad que se beneficia de programas de prevención en pacientes de riesgo promedio o elevado, ya que los mismos permiten reducir su incidencia y mortalidad.…”

Section: Discussionunclassified

“…Las últimas evidencias sugieren que la incidencia de CCR está aumentando en adultos menores a 50 años hasta en un 51%, representando del 7-15 % del total de los CCR 13 . En base a esta evidencia la mayoría de las guías actuales sugieren iniciar el SCCR a los 45 años en personas de riesgo promedio, y se espera que las próximas muestras de pacientes estén constituidas por individuos más jóvenes 23,24 . No se encontró una asociación significativa en pertenecer a un grupo de riesgo y la ausencia o presencia de pólipos.…”

Section: Discussionunclassified

Utilidad de los factores pronósticos para la detección de lesiones pre-neoplásicas de colon

Bedini¹,

Trakál²,

Trakál³

2019

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INTRODUCCIÓN: El cáncer colorrectal (CCR) representa un problema de salud pública mundial. El objetivo de la participación de los pacientes en programas de screening de cáncer colorrectal (SCCR) es realizar undiagnóstico temprano y reducir la mortalidad. Los estudios endoscópicos son una herramienta clave para estratificar el riesgo y establecer el seguimiento de los pacientes. OBJETIVOS: Determinar la prevalencia de adenomas diagnosticados durante todos los estudios endoscópicos realizados en un periodo de 5 años. Establecer los factores de riesgo asociados a adenomas colorrectales. Estratificar en diferentes tipos de riesgo según la historia clínica del paciente y correlacionarlo con los hallazgos anatomopatológicos de los pólipos y el grado de displasia. PACIENTES Y MÉTODOS: Estudio observacional, retrospectivo, analítico. La población estudiada estuvo conformada por pacientes mayores de 18 años que se realizaron una videocolonoscopía (VCC) en el servicio de Gastroenterología de la Clínica Universitaria Reina Fabiola, en el período comprendido entre 1 diciembre de 2011 y 30 abril de 2017. Las fuentes de datos fueron informes de historia clínica, resultados de estudios endoscópicos y de anatomía patológica.Se analizaron variables demográficas, factores de riesgo para CCR, resultado anatomo-patológico de los pólipos y grado de displasia. Análisis estadístico: Para determinar la relación de diferentes factores de riesgos con el tipo de pólipo obtenido, se realizó un análisis univariado; test de Chi Cuadrado para variables categóricas y test T de Student para variables continuas. Todas las variables significativas en el análisis univariado se incluyeron en un análisis multivariado de regresión logística múltiple. RESULTADOS: La prevalencia de adenomas fue del 26%. Se halló una asociación entre el sexo masculino (p= 0,44), edad mayor a 50 años (p=0,001) y la detección de pólipos durante las colonoscopias de SCCR. Pertenecer a un grupo de riesgo determinado no influyó en el diagnóstico de adenomas (p=0,156). CONCLUSIONES: La prevalencia de pólipos de colon fue similar a la reportada por otros estudios.En el programa de SCCR, se observó una mayor frecuencia de pólipos en pacientes de sexo masculino y mayores de 50 años. Los grupos de riesgo no influyeron en el diagnóstico de adenoma.

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Clinical practice guideline. Diagnosis and prevention of colorectal cancer. 2018 Update

Cited by 41 publications

References 3 publications

Not so FAST. Commentary on the article “Appraisal of the faecal haemoglobin, age and sex test (FAST) score in assessment of patients with lower bowel symptoms: an observational study”

Not so FAST. Commentary on the article “Appraisal of the faecal haemoglobin, age and sex test (FAST) score in assessment of patients with lower bowel symptoms: an observational study”

Impact of the faecal immunochemical test on colorectal cancer survival

Utilidad de los factores pronósticos para la detección de lesiones pre-neoplásicas de colon

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